2009 Cancer Annual Report

2009 Cancer Annual Report About the Cover Design elements of the Cancer Annual Report are based on the famous double helix model of the DNA molecule discovered by Watson and Crick in the mid-twentieth century combined with the universal pink ribbon symbol of breast cancer awareness. FACT American women have the highest incidence rates of breast cancer in the world. December 30, 2009 We are pleased to present the 2009 Cancer Annual Report. This year’s report includes a review of 2,953 breast cancer cases diagnosed at Woman’s Hospital between 1998-2008. You will note that 30% of breast cancer cases were diagnosed in women less than 50 years old compared to 22% diagnosed in this age group nationally. This will be important for us to consider when reviewing and evaluating recommended changes for mammography screening. In addition to reporting our cancer statistics, we have focused on the evolving understanding of the role that genetics plays in the development of cancer. Since the 1953 discovery of DNA structure by Watson and Crick and particularly with the completion of the human genome project in 2000, we have begun to understand the genetic language of cancer. Recent breakthroughs are allowing researchers to identify patients at increased risk for the development of cancer, to identify cancer earlier, and to design treatments that target the genetic errors in cancer cells. We hope, with this increasing knowledge, we will no longer view cancer as simply a life threatening disease, but as a group of disorders—often genetic in origin—amenable to new and more effective therapies. Sincerely, David Boudreaux, MD Beverly Ogden, MD CANCER LIAISON PHYSICIAN CHAIRMAN CANCER COMMITTEE 1953 Drs. James Watson and Francis Crick’s discovery of the double helix structure of DNA is the historical milestone that leads to the development of the field of molecular biology. 1 The Inheritance of Cancer Questions about family history have Guidelines used to determine an CancerAll cancers have genetic basis, which long been a standard part of any history inherited predisposition to cancer means it takes a change (mutation) in a and physical. While only 10% of cancers include: cell’s genes/DNA to turn a normal cell have been proven to have a genetic • Family history of two or more family into a cancer cell. Cancer is not a one- component, many cases of inherited members (on the same side of the step process. Most human tumors result breast and ovarian cancer are linked family) with cancer; to BRCA1 and BRCA2 gene mutations. Discussionfrom a complex sequence of mutational • Families of Ashkenazic Jewish descent; events, each of which contributes to the BRCA1 mutations are associated with breakdown of regulatory mechanisms that the risk of development of breast cancer, • Family history of early age onset cancer; govern normal cell behavior. Although all ovarian cancer, colon cancer, cervical • Family history of bilateral breast cancer; cancers are genetic, only approximately cancer, uterine cancer, pancreatic cancer 10% of cancers are believed to be and prostate cancer in families. BRCA2 • Family history of more than one type of inherited. Inherited cancer occurs when mutations are associated with the risk of cancer; and, a patient is born with a genetic mistake development of breast cancer, ovarian • Family history of male breast cancer. that predisposes that person to develop cancer, male breast cancer, melanoma, cancer. As an inherited disorder, cancer is pancreatic, stomach, gallbladder and bile Guidelines for the management of a an autosomal dominant disease process. duct cancer. family with an inherited risk for cancer: If a patient inherits a gene for cancer, Prior to testing for such mutations, genetic A woman with an inherited risk of that individual has approximately an 85% counseling is essential, because the test breast cancer may choose prophylactic chance of developing cancer by the age results may affect not only the patient’s mastectomy/oophorectomy or of 65 and a 50% chance of passing this life but the lives of an entire family for surveillance. A non-surgical management genetic predisposition on to offspring. generations. After decades of aggressive pathway includes six-month imaging educational campaigns by cancer societies, of MRI alternating with mammography the message about the importance of beginning at age 25, transvaginal family history and early detection has been ultrasound of the ovaries for early heard–and heeded. detection of ovarian lesions and also evaluation of CA 125 serum levels starting These days, requests for genetic testing at age 25. Beginning between the ages from concerned patients increase every of 20-30, colonoscopy screenings should year. However, genetic testing isn’t be performed every one-two years and, appropriate for all families. While testing subsequently, every year after age 40. for cancer genes has been available since Endometrial biopsies should be performed the mid-1990s, only recently have medical yearly beginning at age 35. Male family professionals pinpointed who should be members should have increased and early tested by reviewing the patient and family PSA screenings and prostate exams. histories. For nearly 15 years, Duane W. Superneau, MD, has counseled Woman’s patients about whether such tests are truly warranted, interpreted screening results and helped those who have been found to have genetic cancer predisposition to understand their risks and manage their health. 1962 Dr. Henry Lynch, a medical resident at the University of Nebraska Medical Center, describes a syndrome 2 that affects a family in which most members died of inherited colon or gynecologic cancer. FACT Breast cancer is about 100 times as frequent among women as among men, but survival rates are equal in both sexes. MRI and Breast Cancer can often mimic a recurrent cancer, and Breast MRI is a very sensitive test, and While mammography and breast MRI can often help distinguish between on occasion normal tissue will mimic a ultrasound remain the main diagnostic the two. Since 2006, over 1,600 breast MRIs mass and require biopsy. Roughly 15% imaging tools for evaluation of breast have been performed at Woman’s. of high-risk screening patients will have an abnormal MRI requiring biopsy, and disease, Magnetic Resonance Imaging One of the limitations of mammography is two-thirds of these will be benign. This (MRI) has become a valuable third imaging the ability to demonstrate a cancer if the false positive result is one limitation of modality for select patients. Woman’s patient has dense underlying breast tissue. MRI. For this reason, MRI screening is not Hospital purchased an MRI scanner in This is a very common situation in younger recommended for the general population. early 2006, and has been a pioneer in the premenopausal women, and even in some community for evaluation of breast cancer postmenopausal patients. MRI imaging Occasionally, a breast mass will be evident and MRI-guided breast core biopsies. is not affected by breast tissue density. only on the MRI scan. In these patients, an MRI of the breast is most commonly For this reason, MRI has become an ideal MRI-guided biopsy is necessary. Woman’s performed after the diagnosis of breast modality to screen patients at high risk for Imaging Department has one of the few cancer. In approximately 20% of these breast cancer. This includes women who MRI-compatible breast biopsy devices patients, MRI will demonstrate more have tested positive for a breast cancer in the region. The addition of MRI to our extensive spread of the cancer in the gene, a very strong family history of breast hospital has brought us to the forefront in affected breast, and helps the surgeon cancer, or history of radiation therapy the battle of breast cancer diagnosis. plan accordingly. Also, in 5% of these to the chest at a young age. Cancers cancer patients, MRI can detect an diagnosed in high-risk patients by MRI unknown cancer in the opposite breast. are typically Stage 0 or 1 as compared After surgery for breast cancer, scar tissue to Stage 1 or 2 disease diagnosed by mammography. Woman’s 2009 Cancer Annual Report 3 FACT There are different types of breast cancer, with different stages, aggressiveness and genetic makeup. The 2009 Cancer Annual Report reflects a review of all breast Breastcancer cases diagnosed at Woman’s Hospital from 1998-2008. In Breast 1998, 194 cases of breast cancer were diagnosed compared to 373 cases diagnosed in 2008 representing an almost two-fold increase. Approximately 30% of cases were diagnosed in women less than 50 years old compared to 22% diagnosed in this age group nationally. Also, 18% of cases were diagnosed at Stage 0, carcinoma Cancerin-situ, compared to 19% found in the National Cancer Data Base. Cancer Mastectomies were performed in 47% of Stage 0 cases, 42% of Stage I cases, 54% of Stage II cases, 84% of Stage III cases, and 48% of Stage IV cases. As expected, 5-year survival data demonstrate better survival in OverviewStage 0, I and II disease with 80%-89% survival in African-American Data women and 84%-95% survival in Caucasian women. A dramatic drop in survival is noted with Stage III disease, 57% for both African- American and Caucasian women. As expected the worst survival is seen with Stage IV disease, with 12% survival among African- American women and 29% survival among Caucasian women. Stage for stage there is a racial disparity in survival rates, except for Stage III disease. This has been a consistent finding in our annual Analysis reports and may reflect underlying intrinsic differences in the overall health of African-American women or other predisposing factors when compared to Caucasian women. 4 Woman’s 2009 Cancer Annual Report The following tables and graphs represent Woman’s Hospital data for Breast Cancer cases for the years 1998-2008 with available comparative Breastnational and regional data.

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